Required Service Application

We appreciate your interest in our organization and are sincerely interested in your background and qualifications. Please answer all questions as thoroughly as possible so we may review this information in consideration of volunteer services with our organization. We are an Equal Opportunity agency and will accept volunteers in designated positions without regard to race, color, religion, sex, national origin, age, disability, veteran status, military status, sexual orientation, genetic information nondiscrimination act or any other locally mandated classifications.

Contact Information

First name:

Last name:

Middle name:

Title:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Email address:

Date of birth:

Criminal History

Have you ever been convicted of a felony or misdemeanor?

Felony or Misdemeanor:

Please list any felony or misdemeanor convictions

Requirements

What are the requirements for these volunteer hours? Who are these required for and when is the due date?

Requirement:

I would like to serve up to:

hours:

When are these hours due by?

Rescue Mission Services

Please indicate if you have received any of the following services from the Rescue Mission; housing, shelter, meals, and/or outreach services.

Have you used Rescue Mission services?:

If yes please list services utilized

Returning Volunteer

Have you volunteer with the Rescue Mission in the past?

Yes or No:

If yes please list all areas you have volunteered

Skills/Interests

Please list or explain any skills or interests you are looking to use/expand while volunteer at the Rescue Mission.

Availability

Please indicate the days and times you are usually available to volunteer.

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Relationship:

Employer

Please list your current or most recent employer, if applicable.

Employer name:

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

I Agree

I certify that the statements and representations made in this volunteer application are true and correct and have been given voluntarily. I understand this information may be disclosed to any party with legal and proper interest, and I release this agency from any liability whatsoever for supplying such information. I understand that I will not be paid for my services as a volunteer. I agree to abide by the policies and proceedures of the Rescue Mission. I understand that the Rescue Mission will not reimburse me for mileage. As a nonpaid volunteer, I understand that I am not covered by the Rescue Mission's medical insurance. If I am injured while donating services to the Rescue Mission, the Rescue Mission is not responsible for any medical fees. I hereby release the Rescue Mission and its representatives from liability and all other persons, corporations or organizations for furnishing such information. As a Rescue Mission volunteer, I agree not to disclose any written or oral information about clients, employees, donors, volunteers, customers or other confidential information - i.e., organization finances. I understand that the Rescue Mission has a legal and ethical responsibility to maintain client, employee, donor, volunteer and customer privacy. I also agree that no photos or videos may be taken while on Rescue Mission property without prior permission of the Communications Director or the designated employee.

By submitting this form, I attest that the information I have provided on the form is true and accurate. I agree that I will obtain and read the Volunteer Handbook and Volunteer Policies. I understand that by submitting this application I will undergo a criminal and background screening process prior to becoming an active volunteer.

I Agree